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Malignant Strictures of the Esophagus, Stomach, and Duodenum: Evaluation and Management

  • Shivangi T. Kothari
  • Vivek KaulEmail author
Chapter

Abstract

Malignant strictures of the esophagus and foregut are a significant cause of morbidity and are encountered quite frequently in a high-volume GI-Oncology practice. The most common etiologies for esophageal strictures are squamous cell cancer and adenocarcinoma of the esophagus, the latter being typically in the setting of Barrett’s esophagus (BE). Most underlying causes for esophageal strictures are intrinsic (luminal) although some are extrinsic, related to intramural or mediastinal/thoracic pathology. Dysphagia and weight loss are the most common presenting symptoms. Malignant gastric and duodenal strictures can be secondary to primary adenocarcinoma of either organ, although pancreatic cancer, metastatic tumors from other organs, and lymphoma are commonly seen in the Western world. The most common presentation is nausea and vomiting due to gastric outlet or small bowel obstruction along with anemia, weight loss, and abdominal pain/distension. Radiologic and endoscopic evaluations are the appropriate investigations which help define the anatomic extent and stage of these lesions. Endoscopic evaluation has emerged as an invaluable diagnostic and staging tool, as well as an effective modality for palliation. Surgery remains the treatment of choice for definitive management, although in many cases it is not a viable option due to extent of disease or patient comorbidity. In this chapter, we will review the evaluation and management of malignant esophageal and foregut strictures.

Keywords

Esophagus Stricture Stenosis Obstruction Luminal narrowing Dilation Stent Malignant Cancer 

Supplementary material

Video 7.1

Malignant Strictures of the Esophagus, Stomach and Duodenum: Evaluation and Management (MP4 192608 kb)

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Center for Advanced Therapeutic Endoscopy, Division of Gastroenterology and HepatologyUniversity of Rochester Medical Center & Strong Memorial HospitalRochesterUSA

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